Development of multi-criteria decision analysis (MCDA) framework for off-patent pharmaceuticals – an application on improving tender decision making in Indonesia

Abstract

BackgroundOff-patent pharmaceuticals (OPPs) hold vital importance in meeting public health objectives, especially in developing countries where resources are limited. OPPs are comprised of off-patent originals, branded generics and unbranded generics; nonetheless, these products are not identical and often there are differences in their equivalence, manufacturing quality standards and reliability of supply. This necessitates reconsideration of the lowest price policy objective in pharmaceutical decision making. The aim of this study was to develop a Multi-Criteria Decision Analysis (MCDA) framework through a pilot workshop to inform the national procurement of OPPs in Indonesia.MethodsAn initial list of potentially relevant criteria was identified based on previous work and a literature review. In a 2-day pilot policy workshop, twenty local experts representing different stakeholder groups and decision-making bodies selected the final criteria, approved the scoring function for each criterion, and assigned weights to each criterion.ResultsAn MCDA framework was proposed for OPP drug decision making in developing countries, which included price and 8 non-price criteria. Based on the pilot policy workshop 6 + 1 criteria were considered relevant for Indonesia: pharmaceutical price (40% weight), manufacturing quality (18.8%), equivalence with the reference product (12.2%), product stability and drug formulation (12.2%), reliability of drug supply (8.4%), real world clinical or economic outcomes, such as adherence or non-drug costs (4.2%) and pharmacovigilance (3.6%).ConclusionsAccording to the pilot policy workshop, other criteria apart from price need to be strengthened in the tendering process. The introduction of additional criteria for OPP procurement in an MCDA framework creates incentives for manufacturers to invest into improved manufacturing standards, equivalence proof, product quality, reliability of supply or even additional real-world data collection, which ultimately may result in more health gain for the society.

Weighing Price and Performance for Decisions for Multisource Pharmaceutical Bidding in Public Hospitals in Thailand

“…The final list of criteria selected in this initial workshop for the resulting MCDA model shows some deviations from the criteria which were previously suggested by an international expert group [2] and which were selected in other countries which adapted the tool to their settings [13]. This reflects the active engagement and contribution of the participants who critically questioned and deliberated each of the proposed criteria in comparison to their current decision processes.…”

“…Although using a standardized process for the workshop and a previously designed Excel-based model template [13], the participants were involved in each step of designing the specific Thai decision tool during a 1-day workshop. Continuing the participatory process by involving the important purchasing stakeholders in the pilots and the evaluation will further foster full transparency and improvement through user feedback, and, finally, it should support endorsement of the process in the specific Thai hospital bidding decision context.…”

“…While the selection of criteria, the ranking, and the weighting require adaptation to the specific decision problem and policy framework, the process itself can be generalized and transferred to other countries or organizations. The foundation for the course of work steps in preparation of the workshop, conduct of the workshop, and follow-up has been formed through the experience from three countries, Indonesia, Kazakhstan, and Vietnam [13,14]. In each of these countries, different types of purchasing or tender decision problems (national purchasing, public tender) had been addressed.…”

“…Two international health policy advisors moderated the workshop following a validated MCDA calculation model and process for local adaptation [13]. Together with the local leader of the initiative, the international experts used a structured process as described in Figure 1 to prepare the workshop, align the participants' expectations and knowledge at the workshop, and to guide the workshop participants through five steps for the local adaptation of the MCDA format.…”

Value-Based Evaluation of Chinese Provincial Health Insurance Policy Schemes

“…The view on the initiative from different perspectives (e.g., academic, policy, industry) was presented through a moderated discussion of participants' expectations and viewpoints on upcoming changes and the expected improvements in health insurance schemes. This was followed by an interactive component to develop a common general decision model following a validated MCDA calculation model and process for local adaptation [30,35]. This portion of the workshop was moderated by two international health-policy advisors.…”